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Underserved Patients Rely on Pharmacists to Fill Care Gap

Nazia S. Babul, Pharm.D., BCACP, Clinical Pharmacist and Clinical Assistant Professor at the University of Illinois College of Pharmacy, counsels patients at CommunityHealth, a free clinic in Chicago.

PROVIDING HEALTHCARE TO UNINSURED AND UNDERINSURED INDIVIDUALS is a challenge that continues to grow. With rising premium costs, the threat of major insurers on the verge of withdrawing from health exchanges, and the potential for reductions in coverage, three health systems — Yale-New Haven Health, Ascension, and the University of Illinois Hospital and Health Sciences System — are calling on clinical pharmacists to help address gaps in care.

Ambulatory Care at Yale-New Haven Health
“Our pharmacists teach underserved patients about their medications, optimize their dose, determine if they’re really receiving the best medication given their particular situation, and find the lowest-cost options for them,” explained Lee Ann Miller, Pharm.D., Director of Clinical Pharmacy Services at Yale-New Haven Health in Connecticut. “These are all steps that can improve adherence and outcomes while also reducing healthcare resource utilization and lowering the overall cost of care.”

Although pharmacists at Yale-New Haven Health provide beneficial care to patients, funding is a concern. Dr. Miller explained that, although pharmacists at ambulatory care clinics often spend up to an hour with a patient, a lack of provider status means they bill Medicaid and Medicare at the lowest-level evaluation and management incident-to code, which reimburses $20 on average.

This financial picture makes it difficult to make a case for expanding the clinical pharmacist workforce beyond the eleven pharmacists who are embedded across the health system’s roughly 200 ambulatory care offices and clinics, explained Dr. Miller. “Moving to value-based payment structures and having provider status would certainly give us the help we need to offer this same level of service at other clinics,” she added.

Ascension’s Social Mission
Despite the low level of reimbursement currently available, pharmacists continue to provide important care. Ascension, the largest nonprofit health system in the country, with facilities in 22 states, offers free medications to those who can’t afford them through one of 45 Dispensary of Hope locations. The Dispensary of Hope program collects medications donated by pharmaceutical manufacturers and distributes them to certain pharmacies and safety-net clinics. At some Dispensary of Hope locations, health leadership may purchase additional medications as part of a safety net formulary for their institutions.

The pharmacy team at the Medical Mission at Home provides medications and counseling to underserved patients.

“In the fourth fiscal quarter of 2017, our Dispensary of Hope pharmacies served 6,460 unique patients,” said Lynn Eschenbacher, Pharm.D., FASHP, National Director of Pharmacy Operations at the Resource Group, which is part of Ascension.

Another Ascension initiative, the Medical Mission at Home project, features daylong community health events that provide patients with primary and speciality care services. As part of the initiative, underserved individuals also receive medications and counseling about their medications, explained David Neu, Pharm.D., MSHSA, Vice President of Pharmacy at Saint Thomas Health, a member of the Ascension network in Nashville, Tenn. According to Dr. Neu, Nashville is host to the largest of the four annual Medical Mission at Home days and recently provided care to more than 750 patients during a single day.

“We see a lot of people with untreated hypertension, diabetes, asthma, or chronic obstructive pulmonary disease — or people who are not adherent to their medication regimen — so pharmacists have an opportunity to make an important impact on their care,” Dr. Neu explained.

Patients are assessed by a nurse and triaged to the appropriate health caregiver, whether that is a physician, pharmacist, or nurse practitioner. Prescriptions can be written and filled onsite using both Dispensary of Hope medications and subsidized medications purchased by the participating Saint Thomas Health hospital, noted Dr. Neu. All medications are provided at no cost to patients during the event.

“Pharmacists also provide counseling and patient education such as inhaler training,” he explained. They assist individuals who need help paying for medications, whether that means obtaining a coupon voucher, connecting with a patient assistance program, or pointing patients to a Dispensary of Hope location. “There’s an aspect of social work to the care our pharmacists provide during these events, which is important as uninsured and underinsured patients have a hard time navigating our health care system to meet their medication needs,” reflected Dr. Neu.

Caring for Chicago’s Poor
At the University of Illinois Hospital and Health Sciences System (UI Health), ambulatory care pharmacists help some of the poorest and most vulnerable communities in Chicago,” said ASHP member Sandra Durley, Pharm.D., Senior Associate Director of Ambulatory Care Pharmacy and Clinical Assistant Professor at the University of Illinois College of Pharmacy, Chicago. “Many of these individuals lack insurance and convenient access to healthcare services and are considered to be medically underserved.” Care is available at UI Health’s on-campus pharmacies and at 20 outpatient clinics and four pharmacy-based clinics staffed with 38 full-time clinical pharmacists.

At Mile Square Health Center, a federally qualified health center that is also part of UI Health, a clinical pharmacist works alongside physicians and nurse practitioners to care for patients with diabetes and other illnesses, many of whom are underinsured or uninsured, explained Dr. Durley. And in an institutional collaboration, two University of Illinois College of Pharmacy clinical pharmacists work four days each week at CommunityHealth, the largest volunteer-based free clinic in the country, she added.

Like Dr. Eschenbacher, Dr. Durley is concerned about the future of underinsured and uninsured patients. Although pharmacy services help improve health outcomes among the underserved, pharmacists are not always compensated. However, she also struck an optimistic note, pointing to the Pharmacy and Medically Underserved Areas Enhancement Act, which, if passed, would recognize pharmacists as healthcare providers under Medicare Part B in medically underserved areas. “That is an important first step in getting compensation for pharmacist services,” Dr. Durley said.

By David Wild

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